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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) � Date Issued ------ _ �___ r__a___ ApplicaTion is hereby made to the San Joaquin Local Health District for a permit to construct and in t This application is made in compliance with County Ordinance N 549. s all the work herein described. JOB ADDRESS AND LOCATION,-,(/o Owner's Narne__��2L/-,_ez------ea-,P_�� OCATION - -- -- --- -------- - ----- --------- ---------- --- -- Phone--------------------- Address--------=-----�,�,-------- .--------- ----------- Contractor's Name___ A. ------------------------------------------------------------- - x,,j- .1 I. Phone- ---------- will serve: Residence -------------------- Installationpartment House ❑ Commercial ❑ Trailer Court ❑ Motel Number of living units: J---- Number of bedrooms - Number of baths _/_._-- Lot size _�� Other ❑ Water Supply: Publics stem _--I-k---/_ w_4)________ ___________ PP Y y ❑ Community system ❑ Private �epth to Water Table :Zi ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay F1 Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ew Construction: Yes ❑ No �— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:7 A Distance from nearest well-----------------Distance from -3 ia.Yv?Y foundation of compartments_. --_ _. Material--- _ ----Size----------------- -----Liquid depth------------ -- ---- -- Disposal Field: Distance from nearest well__..-- ---- _ -Distance from foundation_______________"_._.Distance to nearest lot line___-_____..._____ y�.;� Number ai fines__________---_-----------_--- -----Length of each line----------- _- Type of filter material---- ----- Width of french.of filter material.-------------- -Total length------------------------------------------ See a Pit: � P Distance to nearest well___-�-�_-_ __bistance rom foundation_- - -P.----- Distance to nearest )of line Number of pits___-j----------- Lining material__ Size: Diameter--, „r �� 1) Cess ool: ❑p Distance f�•om nearest well__-_-__--------_Distance from foundation_ ___ ____________ Lining material__.__-__-____"___---__. Size: Diameter------------------ -- -- -Is - --------Depth-- - ----- ----- ------- ---- ----- ----- Liquid Capacity- ------------------------ga[s. Privy: Distance from nearest well__,_.__---_--_ - - El Distance to nearest lot line. -_-- -Distance from nearest building-,--- _-- ------------------------- - Remodeling and/or repairing (describe):___-_--- ------------------- -- ------------------------ ------- --------------------------------------------------------------------------------------------------------------------------------------------- -------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)_ --�� , _. - . BY• c>•- t_._. 1 1Contractor) __: of plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- _-_---- -_ " --- - ----- ---- --------------------------------------------- REVIEWED BY---- ._ DATE ------------ ------ ----------- ----------------- DATE---'JT iJILDING PERMIT ISSUED-- ------- ------ ------ ---- ------ ------- ------ - ------- ------ ----------------------- - Alterations and/or recommendations:---------_--_-- - DATE--------------- ------4 ------------------ --------- ----- - ----- FINAL INSPECTIONjr p - / -- ------ --- , Date....... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California Ma Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California ES--9-2M ; ' Revised W-2100